Outcomes of Applications for Disability Benefits

Note

The tables in this section provide data on the outcomes of applications for disability benefits. The data on applications are derived from the Social Security Administration's (SSA's) Disability Research File maintained by the Office of Disability Programs. Each year this file is updated with information about applications for disability benefits that is then used to determine the outcome of those applications. The outcome data in these tables are reported by year of filing and include decisions made through the administrative appeals process.

Table 58 shows the total number of applications filed in a year, the number denied for nonmedical reasons before a medical decision is made (technical denials), the number that are pending a final decision, the outcome of applications for which a medical allowance or denial was made, and award and allowance rates. Applications for which a medical allowance or denial decision was made but which were subsequently denied for nonmedical reasons are shown under the medical decision header as subsequent denials. The most common nonmedical reason for denying a claim is insufficient number of recent work credits.

The allowance rate is calculated by dividing the number of medical allowances (including subsequent technical denials) by the total number of medical decisions made for a 1-year cohort. The award rate is a broader program measure that is calculated as the number of allowances minus subsequent denials divided by total applications (minus pending claims) filed for a given year.

Claims that remain pending after 6 years are probably the result of imperfect data rather than excessive delays in the decisionmaking process. It is highly probable that decisions have been rendered on most of the older claims. For more recent years, the award and allowance rates will change as decisions are made on pending claims.

Tables 59–61 show the allowance rate for Social Security only and the Social Security portion of concurrent applications (which are claims for both Social Security and Supplemental Security Income disability benefits). Each table shows a different level in the administrative decisionmaking process, that is, initial adjudicative, reconsideration, and hearing or higher level.

Beginning with 2000, the proportion of claims awarded at each level of the process changed as a result of the Prototype Process being tested in 10 states. Under this test, the reconsideration step of the appeals process was eliminated for applications filed October 1, 1999, or later. Elimination of the reconsideration level in these states results in a decrease in the aggregate proportion of claims awarded at this step.

This section also includes one table that shows the reason for medical allowance and one that shows the reason for medical denial (Tables 62 and 63). The reasons are derived from the sequential evaluation process used by decisionmakers. SSA maintains a list of impairments that are considered disabling under its regulations. An applicant can be found to be disabled if he or she

has a listed impairment,

has a severe impairment that is equal to a listed impairment,

has a severe impairment when medical and vocational factors are considered, or

had previously established entitlement to a disability benefit.

An applicant can be denied benefits if he or she

has an impairment that is not expected to last 12 months,

has an impairment that is not considered severe,

is able to perform his or her usual type of work,

is able to perform another type of work, or

has an impairment resulting from drug addiction or alcoholism, provides insufficient medical evidence, fails to cooperate, fails to follow prescribed treatment, does not want to continue development of the claim, or returns to substantial work before disability can be established.

Chart 11. Final outcome of disabled-worker applications, 1996–2005

The final award rate for disabled-worker applicants has varied over time, averaging nearly 48 percent for claims filed from 1996 through 2005. The percentage of applicants awarded benefits at the initial claims level averaged 31 percent over the same period and ranged from a high of about 35 percent to a low of 25 percent. The percentage of applicants awarded at the reconsideration and hearing levels are relatively constant, averaging 4 percent and 13 percent, respectively. Denied disability claims have averaged about 49 percent.

The proportion of claims awarded at each level of the process is likely to change as a result of the Prototype Process being tested in 10 states. Under this test, the reconsideration step of the appeals process was eliminated for applications filed October 1, 1999, or later. Elimination of the reconsideration level in these states is likely to result in a decrease in the overall proportion of claims awarded at this step.

NOTES: Data for the initial and reconsideration levels are current through June 2006. Data for the hearing level or above are current through August 2006.

Because a number of applications remain pending for more recent years, the award and allowance rates will change over time. Cases can be pending at the initial or appellate levels and can include either medical or technical issues.

Data include decisions for Social Security–only applications and applications for both Social Security and Supplemental Security Income (SSI); they do not include SSI-only applications.

Data from 1992 to 1998 are available for disabled workers only.

a. Applications were denied for nonmedical reasons; therefore no decision was made on severity of impairment.

b. Rate determined by dividing awards by all applications minus pending claims for that year.

c. Rate determined by dividing medical allowances by all medical decisions for that year.

d. Applications were denied for nonmedical reasons after a decision was made that the applicant did not meet the medical severity criteria for disability benefits.

e. Applications were denied for nonmedical reasons after a decision was made that the applicant met the medical severity criteria for disability benefits.

NOTES: Data for the initial and reconsideration levels are current through June 2006. Data for the hearing level or above are current through August 2006.

Because a number of applications remain pending for more recent years, the numbers and percentages will change over time.

Applications with a medical decision may be pending a final nonmedical decision or be subsequently denied for nonmedical reasons.

Data include decisions for Social Security–only applications and applications for both Social Security and Supplemental Security Income (SSI); they do not include SSI-only claims.

Data from 1992 to 1998 are available for disabled workers only.

a. Includes applications for which the disability was previously established and those for which the basis for the determination is not available. The majority of applications for which the basis of determination is not available are cases allowed at or above the hearing level.

NOTES: Data for the initial and reconsideration levels are current through June 2006. Data for the hearing level or above are current through August 2006.

Because a number of applications remain pending for more recent years, the numbers and percentages will change over time.

Applications with a medical decision may be pending a final nonmedical decision or be subsequently denied for nonmedical reasons.

Data include decisions for Social Security–only applications and applications for both Social Security and Supplemental Security Income (SSI); they do not include SSI-only claims.

Data from 1992 to 1998 are available for disabled workers only.

a. Applicant has an impairment resulting from drug addiction or alcoholism, provided insufficient medical evidence, failed to cooperate, failed to follow prescribed treatment, did not want to continue development of the claim, or returned to substantial work before disability could be established. Also includes cases denied at or above the hearing level for which the basis of determination is not available.